By Justin Yamashita, MSc. Benchtop, site, CRO: three levels of basic and clinical research, explained without spin.

From Open Label Media, the team behind Root to Rx, come two free tools for telling what's true. Got Skepticism? runs any claim through a five-move toolkit to test whether your confidence is earned, and Stay in the Room shows you how to disagree without a fight. Both play in your browser in about two minutes at openlabelmedia.com.

The bad-actor record is real, documented, and worse than most defenders admit. It also doesn’t establish what the 'pharma is all about profit' argument needs it to establish. Both of those statements are true at once, and this issue holds them there.

Generalizing from specific bad actors to an entire industry's output is the same logical move as generalizing from a single trial to a population.

The Gleevec arc is closed. The access gap is named. This issue turns to the systemic critique underneath the distrust driving that gap: the 'pharma is all about profit' argument. The goal is not to defend the industry. It is to examine the claim with the same standard the brand applies to everything else.

Shkreli and daraprim: Martin Shkreli was convicted of securities fraud in 2017. The daraprim price increase was not itself the basis of criminal charges but drew significant congressional attention. It is useful as an illustration of the price-setting freedom that exists in the US market for off-patent drugs with small markets. It is not representative of standard industry pricing, but it is an example of what the system permits.

Purdue and the opioid crisis: the degree to which Purdue's OxyContin marketing contributed to opioid-related deaths is documented in court proceedings, congressional testimony, and investigative journalism. Internal documents showed awareness of addiction risk that was not reflected in marketing materials. In June 2024 the Supreme Court rejected a bankruptcy deal that would have shielded the Sackler family from opioid lawsuits. A revised agreement followed: in 2025 Purdue and the Sacklers reached a roughly $7.4 billion settlement, which a federal bankruptcy judge formally approved in November 2025, ending the family's ownership of Purdue and its ability to sell opioids in the United States. The FDA's role in the original 1995 label language is also a subject of ongoing analysis.

AbbVie and biosimilar delay: the Humira patent thicket involved both utility and formulation patents, with more than 240 US patent applications filed, about 89% of them after FDA approval (I-MAK). US biosimilar competition was held off until 2023, roughly 5 years after biosimilars launched in Europe in October 2018.

Pay-for-delay: the FTC publishes an annual report on brand-generic settlement agreements. Reverse payments, brand paying generic to stay off market, were the subject of FTC v. Actavis (2013), in which the Supreme Court held these agreements can violate antitrust law and are subject to rule-of-reason analysis. The FTC has continued to document cases.

Drug development economics are structurally incompatible with a pure-profit optimization model for large categories of drugs.

Rare diseases: the Orphan Drug Act of 1983 created tax incentives and extended exclusivity for drugs targeting conditions affecting fewer than 200,000 people in the US. The policy exists because without it the market is too small to recover development costs. Its very existence is evidence that pure market logic does not fund rare disease research adequately.

Historically unattractive oncology: pancreatic cancer has a low 5-year survival rate, about 13 percent overall (American Cancer Society, 2025, based on SEER data), most patients are diagnosed at an advanced stage, and historically available therapies have shown minimal survival benefit. Commercial logic alone would not prioritize it. Revolution Medicines' decade-long effort to drug the RAS oncogene family produced daraxonrasib, and in 2026 a Phase 3 trial (RASolute 302) reported a roughly doubled median overall survival versus chemotherapy in previously treated metastatic pancreatic cancer, about 13.2 versus 6.6 months (hazard ratio 0.40). A current, peer-reviewed example that contradicts the 'only chases easy money' narrative.

The public funding layer: the NIH funds basic research underlying a significant proportion of drugs that reach patients. A 2018 PNAS analysis reported that every one of the 210 drugs approved by the FDA between 2010 and 2016 had some NIH-funded research in its lineage.

The Drugs for Neglected Diseases initiative (DNDi) is a not-for-profit developer of treatments for diseases primarily affecting low-income populations, where commercial markets are insufficient. It has produced approved treatments for sleeping sickness, Chagas disease, and hepatitis C in resource-limited settings.

DNDi runs on pooled funding from governments, foundations, and international health organizations, and partners with companies for manufacturing and regulatory expertise without ceding IP control in ways that would price out the target populations.

The model works for a specific type of development: well-defined infectious-disease targets, a global-health mandate, and donor funding. It does not scale to the full range of drug development without a corresponding scale of public funding. The thought experiment worth running: what would it cost, publicly, to replace private capital entirely, and what would the tradeoffs be for innovation speed and commercial-risk tolerance? That is a policy debate worth having. It is not answered by 'pharma is all about profit.'

If you work in clinical research or regulatory affairs: the practices named in Plain Talk, ghost-writing, selective publication, and off-label promotion, affect the information environment you work in. The literature is not uniformly contaminated, but the bias from selective publication is documented and measurable. Cochrane and systematic reviews are designed in part to surface the full dataset, including unpublished trials. Prospective registration on ClinicalTrials.gov before enrollment was created specifically to reduce selective publication. The imperfection of these tools is real; their existence reflects a real problem being addressed.

If you are a patient or patient advocate: the bad-actor record does not tell you whether any specific drug is safe or effective. That depends on the trial data and the FDA review, both of which have structural independence from the marketing and pricing decisions made after approval. The Pfizer marketing fraud settlement was for a painkiller's off-label promotion. It does not change the safety profile of any other drug the company makes. Running Q4 on the source of a claim about a specific drug remains more useful than a categorical distrust based on behavior in a different product area.

If you are a general reader: the honest version is that the industry has a bad reputation because it has done things that warrant one, and the same industry produces the pipeline the bad-actor narrative says cannot be trusted. Both are true. The Skeptic's Toolkit is the mechanism for holding both without collapsing into 'pharma is good actually' or 'nothing they make can be trusted.'

FILL THE GAP   Free tools for the gaps above. The Skeptic's Toolkit (the 10 questions) is free in the Field Guide. To check whether a trial was registered before it enrolled, search ClinicalTrials.gov or go our Global Clinical Trials Registry. The free Patient Logs at shop.roottorx.com track your medical history, every medication and supplement for your next appointment.

Applied to the 'pharma is all about profit' claim itself. Who benefits if it is believed wholesale? The supplement, wellness, and alternative-health industries are significant beneficiaries of pharmaceutical distrust. That does not make the underlying criticisms false. It makes the source of the framing worth examining.

Applied in both directions. The same evidentiary standard readers now apply to vaccine safety claims (Issues 003b, 007) should apply to claims about the industry's motives. Generalizing from specific bad actors to an entire industry's output is the same logical move as generalizing from a single trial to a whole population, and the brand calls that out everywhere else.

Citations verified June 2026.

[1] Pay-for-delay / reverse payments: FTC v. Actavis, 570 U.S. 136 (2013); US Federal Trade Commission annual reports on pharmaceutical settlement agreements (ftc.gov).

[2] Rare disease incentives: Orphan Drug Act of 1983 (Pub. L. 97-414).

[3] Public funding underlies approvals: Galkina Cleary E, et al. Contribution of NIH funding to new drug approvals 2010-2016. Proc Natl Acad Sci USA. 2018;115(10):2329-2334. https://doi.org/10.1073/pnas.1715368115

[4] Pfizer 2009 settlement ($2.3 billion; Bextra and others; off-label promotion and kickbacks): US Department of Justice press release, September 2009.

[5] Drug development cost: Wouters OJ, McKee M, Luyten J. JAMA. 2020;323(9):844-853 (median about $985 million, mean about $1.3 billion, counting failed trials). Older estimates near $2.6 billion (DiMasi et al., 2016) are contested.

[6] Neglected-disease alternative model: Drugs for Neglected Diseases initiative (DNDi), dndi.org.

[7] Pancreatic cancer survival (about 13% overall): American Cancer Society, Cancer Statistics 2025 (SEER data). [8] Daraxonrasib Phase 3: O'Reilly EM, et al. N Engl J Med. 2026. https://doi.org/10.1056/NEJMoa2605555

[9] Purdue Pharma / OxyContin: US Department of Justice and court filings; Harrington v. Purdue Pharma, US Supreme Court, June 2024 (Sackler liability shield rejected); revised $7.4 billion settlement approved by the US Bankruptcy Court, November 2025.

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